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. 2009 Jan 13;53(2):184-92.
doi: 10.1016/j.jacc.2008.09.031.

Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry

Adrian F Hernandez  1 , Bradley G Hammill, Christopher M O'Connor, Kevin A Schulman, Lesley H Curtis, Gregg C Fonarow
Affiliations

Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry

Adrian F Hernandez et al. J Am Coll Cardiol. .

Abstract

Objectives: We sought to examine associations between initiation of beta-blocker therapy and outcomes among elderly patients hospitalized for heart failure.

Background: Beta-blockers are guideline-recommended therapy for heart failure, but their clinical effectiveness is not well understood, especially in elderly patients.

Methods: We merged Medicare claims data with OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) records to examine long-term outcomes of eligible patients newly initiated on beta-blocker therapy. We used inverse probability-weighted Cox proportional hazards models to determine the relationships among treatment and mortality, rehospitalization, and a combined mortality-rehospitalization end point.

Results: Observed 1-year mortality was 33%, and all-cause rehospitalization was 64%. Among 7,154 patients hospitalized with heart failure and eligible for beta-blockers, 3,421 (49%) were newly initiated on beta-blocker therapy. Among patients with left ventricular systolic dysfunction (LVSD) (n = 3,001), beta-blockers were associated with adjusted hazard ratios of 0.77 (95% confidence interval [CI]: 0.68 to 0.87) for mortality, 0.89 (95% CI: 0.80 to 0.99) for rehospitalization, and 0.87 (95% CI: 0.79 to 0.96) for mortality-rehospitalization. Among patients with preserved systolic function (n = 4,153), beta-blockers were associated with adjusted hazard ratios of 0.94 (95% CI: 0.84 to 1.07) for mortality, 0.98 (95% CI: 0.90 to 1.06) for rehospitalization, and 0.98 (95% CI: 0.91 to 1.06) for mortality-rehospitalization.

Conclusions: In elderly patients hospitalized with heart failure and LVSD, incident beta-blocker use was clinically effective and independently associated with lower risks of death and rehospitalization. Patients with preserved systolic function had poor outcomes, and beta-blockers did not significantly influence the mortality and rehospitalization risks for these patients.

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Figures

Figure 1
Figure 1
Derivation of Analysis Populations Eligible for Beta-Blocker With Left Ventricular Systolic Dysfunction and Preserved Systolic Function
Figure 2
Figure 2. One-Year Survival for Eligible Patients With Left Ventricular Systolic Dysfunction on Beta-Blocker Therapy vs Patients Not on Beta-Blocker Therapy at Discharge
Comparison of Kaplan-Meier survival curves at 1 year. The solid line represents eligible patients who were not on beta-blocker therapy at discharge. The dashed line represents eligible patients who were on beta-blocker therapy at discharge.
Figure 3
Figure 3. One-Year Survival for Eligible Patients With Preserved Systolic Function on Beta-Blocker Therapy vs Patients Not on Beta-Blocker Therapy at Discharge
Comparison of Kaplan-Meier survival curves at 1 year. The solid line represents eligible patients who were not on beta-blocker therapy at discharge. The dashed line represents eligible patients who were on beta-blocker therapy at discharge.
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